Cognitive and academic outcomes of large-for-gestational-age babies born at early term: A systematic review and meta-analysis.

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Xuan Zhao, Alice Poskett, Marie Stracke, Siobhan Quenby, Dieter Wolke
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引用次数: 0

Abstract

Introduction: Early induction of labor (37+0-38+6 gestational weeks) in large-for-gestational-age infants may reduce perinatal risks such as shoulder dystocia, but it may also increase the long-term risks of reduced cognitive abilities. This systematic review aimed to evaluate the cognitive and academic outcomes of large-for-gestational-age children born early term versus full term (combined or independent exposures).

Material and methods: The protocol was registered in the PROSPERO database under the registration no. CRD42024528626. Five databases were searched from their inception until March 27, 2024, without language restrictions. Studies reporting childhood cognitive or academic outcomes after early term or large-for-gestational-age births were included. Two reviewers independently screened the selected studies. One reviewer extracted the data, and the other double-checked the data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. In addition to narrative synthesis, meta-analyses were conducted where possible.

Results: Of the 2505 identified articles, no study investigated early-term delivery in large-for-gestational-age babies. Seventy-six studies involving 11 460 016 children investigated the effects of either early-term delivery or large-for-gestational-age. Children born at 37 weeks of gestation (standard mean difference, -0.13; 95% confidence interval, -0.21 to -0.05), but not at 38 weeks (standard mean difference, -0.04; 95% confidence interval, -0.08 to 0.002), had lower cognitive scores than those born at 40 weeks. Large-for-gestational-age children had slightly higher cognitive scores than appropriate-for-gestational-age children (standard mean difference, 0.06; 95% confidence interval, 0.01-0.11). Similar results were obtained using the outcomes of either cognitive impairment or academic performance.

Conclusions: No study has investigated the combined effect of early-term delivery on cognitive scores in large-for-gestational-age babies. Early-term delivery may have a very small detrimental effect on cognitive scores, whereas being large for gestational age may have a very small benefit. However, evidence from randomized controlled trials or observational studies is required.

早产巨大胎儿的认知和学习成绩:系统回顾和荟萃分析。
引言:早引产(37+0-38+6 孕周)可降低肩难产等围产期风险,但也可能增加认知能力下降的长期风险。本系统综述旨在评估早产与足月(合并或独立暴露)大胎龄儿的认知和学习成绩:该方案已在 PROSPERO 数据库中注册,注册号为:CRD4202452862。CRD42024528626。对五个数据库进行了检索,检索时间从开始到 2024 年 3 月 27 日,没有语言限制。报告了早产儿或胎龄大新生儿的儿童认知或学习成绩的研究均被纳入其中。两名审稿人独立筛选了所选研究。一位审稿人提取数据,另一位审稿人复核数据。偏倚风险采用纽卡斯尔-渥太华质量评估量表进行评估。除叙事综合外,在可能的情况下还进行了荟萃分析:在已确认的 2505 篇文章中,没有一项研究调查了大妊高征婴儿的早产情况。涉及 11 460 016 名儿童的 76 项研究调查了早产或胎龄过大的影响。与孕 37 周出生的婴儿相比,孕 38 周出生的婴儿(标准平均差异为-0.04;95% 置信区间为-0.08-0.002)的认知分数较低(标准平均差异为-0.13;95% 置信区间为-0.21--0.05),而孕 37 周出生的婴儿(标准平均差异为-0.13;95% 置信区间为-0.21--0.05)的认知分数较高。大孕期儿童的认知分数略高于适孕期儿童(标准平均差为 0.06;95% 置信区间为 0.01-0.11)。使用认知障碍或学习成绩的结果也得出了类似的结果:结论:目前还没有研究调查过早产对胎龄较大婴儿认知分数的综合影响。早产可能会对认知分数产生很小的不利影响,而胎龄大可能会带来很小的益处。不过,还需要随机对照试验或观察性研究提供证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.00
自引率
4.70%
发文量
180
审稿时长
3-6 weeks
期刊介绍: Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.
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